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New Member Application
(*) Denotes Required Fields
Company Information
Company: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Web Site:
Online Links:
Business Category #1:
Please contact us with questions regarding business categories.
Full-time Employees:
Part-time Employees:
Members-only Access
Members-only allows you to update your information online via a secure login.
Admin E-mail: *
Password: *
Verify Password: *
Primary Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Billing Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Home-Based Business:   
Investment Schedule
Business Type
Annual Investment:$325.00
Number of EmployeesAmount
1 thru 5$325.00
6 thru 20$575.00
21 thru 50$900.00
51 thru 300$1,750.00
Over 300 Employees$2,500.00
Registration Fee$50.00
__________
Total:$375.00
Businesses with the same owner, name and business category having multiple locations may join initial location at full investment level and subsequent locations at a fifty percent per additional location. Please contact the chamber to register subsequent locations at the discounted rate.
(*) Denotes Required Fields

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